Inquest to be called into death of Windsor man shot by police: coroner's office

CBC Windsor has learned an inquest into Matthew Mahoney's death will take place.

An inquest into Mahoney's death is being considered mandatory

The Mahoney family remembers Matthew as a brilliant and loving man who would listen to anyone about their own struggles. (Michael Mahoney)

CBC Windsor has learned an inquest into Matthew Mahoney's death will take place.

Mahoney was shot and killed by police in an altercation in March of 2018. A Special Investigations Unit cleared officers, determining they were justified in using lethal force. Since his death, Mahoney's family members have asked for a coroner's inquest. After the SIU report was release last week, police and healthcare officials have echoed the call for an inquest.

The inquest is described as an "open and public examination of the circumstances of the death, with a jury possibly making recommendations," said Cheryl Mahyr, a spokesperson for the Office of the Chief Coroner and Ontario Forensic Pathology Services.

The goal of an inquest is to find out if or how future deaths in similar circumstances could be prevented. In the case of Mahoney, it may look into the police actions but also into the inner workings of the health care system that led to his confrontation with police officers and being shot by them.

Mahoney's death began to be investigated immediately, as are most deaths in similar situations, said Mahyr. She said there is no date for an inquest at this point, but they typically begin about two years from the death (Mahoney died in March 2018).

"Section 10 of the Coroner's Act lays out the circumstances in which a death must be investigated," added Mahyr. She said the section is "quite extensive" but Mahoney's death falls under those circumstances.

According to Mahyr, the purpose of an investigation is to answer five questions:

  1. The name of the person who died
  2. When they died
  3. Where they died
  4. Medical cause of death
  5. Manner of death

When it's not mandatory, the coroner's office then has to determine if it is in the public interest to conduct an inquest — and all deaths the office investigates are considered for inquest.

Laws around mandatory inquests changed last year

The laws surrounding inquests changed under the Wynne Liberal government, making inquests mandatory when the death was a direct result of police action. Before that, it was ambiguous.

"Before that act amendment came into force, what made a police shooting mandatory was if the person was considered to be in the custody of police at the time of their death," said Mahyr. "You ask anybody what that means and you'll get all kinds of different interpretations."

Mahoney died before the changes came into place. That said, the coroner's office takes the position that, even under the old law, Mahoney's death should have been considered a mandatory case for an inquest.

"We are considering [an inquest into] the death of this young man to be mandatory given the unique circumstances of his death," said Mahyr. 

The Mahoney family started calling for an inquest early on.

"We have questions that aren't exclusively related to police, like why wasn't he receiving healthcare or is there anything that could have prevented him from being there that morning," said Mahoney's brother Michael. "It's positive news that this is moving forward."

Watch Windsor police chief Al Frederick speaking to media, supporting the call for a coroner's inquest:

Windsor police chief Al Frederick reacts to Mahoney's family who says the healthcare system failed their son. 0:38

Family can take part in inquest

During an inquest, different parties can be granted "standing," which means they can comment or call witnesses. Families are always granted standing.

"They can question witnesses, they can address members of the jury," said Mahyr. "They may bring issues and topics to the fore for examination if they feel it's appropriate."

Michael Mahoney and his family were calling for an inquest into the death of his brother. (Dan Taekema/CBC)

Mahyr said there's an "easy application process" to participate and that not all families wish to do so. 

"Sometimes they just want to observe," said Mahyr. "We leave it up to families."

Michael said the family has intended to be as involved as possible as a family.

"From day one, the SIU explained to us that we would have to apply for standing," said Michael. "We are going to be as involved as possible."

There is no "typical" amount of time that an inquest might take. 

Recommendations are only for consideration purposes

"They are only a recommendation, nobody has to implement them," said Mahyr. There is no legal requirement for the recipient of a recommendation to make any changes. "They're not mandatory."

Mahyr said the recommendations can be helpful for police or medical personnel to look at policies and procedures.

Robert Moroz with the Canadian Mental Health Association said the coroner's inquest is something they can learn from.

"It allows us to review our processes and review what models of care we're using," said Moroz. He's hoping for recommendations on how to improve their care plans. 

"An inquest gives some validity to the conclusions," said Moroz. "They might look at a lot of things, but anything that comes out of it would be helpful."

According to Michael, the family is hoping for recommendations about adults with mental illness and how they're handled by the system. 

"If we know someone has a problem that will stop them from making an informed decision, why is it that they can make decisions in a bubble," said Michael. The family tried to be involved in Mahoney's healthcare, but were unable to do so.

Brenda and Michael Mahoney review the SIU report which concluded officers were justified in using lethal force. (Jason Viau/CBC)

"What we're talking about at the end of the day is keeping individuals safe," said Mahoney. "That's a place to start."

Michael said the situation was new, and "scary."

"Every single time we have to talk about Matthew it takes us back to that day," said Michael. "That has a pretty strong effect on my whole family. It has not been easy and it's not getting easier yet."

Both Michael and his mother have spoken previously about undergoing grief counseling. 

According to the Office of the Chief Coroner, 252 recommendations were made during 28 of the 32 inquests held in 2015. When organizations were polled, nine per cent of those recommendations were implemented and more than 23 per cent were under consideration.

The office will release a news release when someone has been assigned to preside over the inquest. That may take a couple of weeks.


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